What I Believe

Life is an experience not to be missed. There are the rough spots in life of course, and then there are the smooth stretches when one is at peace with the world. One fine solution for the feeling of depression, insecurity, and futility is to stop and think, Would life be full if it were a life of ease; would life have depth

A Survey of Information Sources Used for Progress Decisions about Medical Students

Although many medical schools have adopted a variety of methods to assess student competency, the extent to which these innovations have changed how decisions about student progress are made is not clear. This paper describes a survey of 126 accredited allopathic U.S. medical schools to determine which information sources are used for decisions related to medical student progress and graduation. Respondents were asked to indicate up to three information sources used for seven specific decisions about student progress. The results indicate that multiple choice questions (MCQs) and faculty ratings remain the most frequently used information sources. Clinical skills education in the pre-clinical curriculum is the area with the broadest use of assessments for progress decisions. Several explanations are suggested for the primacy of MCQs and faculty ratings in student decisions, including familiarity for faculty and students, ease of implementation and the resources required for the adoption of other assessment strategies

The patient’s story: Integrating the patientand physician-centered approaches to interviewing

• Patients produce biopsychosocial stories that integrate material from the medical and personal aspects of their lives. Capturing the personal aspect of the story requires that a patient-centered approach to clinical interviewing complement the equally important physician-centered approach. Patient-centered interviewing actively involves the patient and ensures that his or her perceptions, needs, and concerns are articulated during the physician-patient interaction. In our article, we define patient-centered interviewing and provide a rationale for using it. We also describe how patientcentered interviewing is done, how it is integrated with the physician-centered approach, and how to understand the product of this complementary approach to clinical interviewing, the patient's biopsychosocial story. According to the biopsychosocial model (1, 2), every patient has a story that demonstrates the interaction among the biologic, psychologic, and social components of his or her life. Gestalt theory posits that people are continuously developing a story that portrays what is most important in their lives (3-6). The patient's story emerges in a meaningful, integrated, and complete way. The physician's task is to elicit and understand this story, for it provides an introduction to who the person is and why he or she is seeing the physician. The story also provides clues to diagnostic and therapeutic issues relevant to the patient's problem. The primary means for eliciting the story is clinical interviewing, the core skill of the clinician (7-9) and a skill that has long been central to the clinical method (10). Unfortunately, physicians frequently do not emerge from an interview with an understanding of the complete story because current interviewing practices often eschew the human dimension in favor of a purely biologic story (11-15). To elicit the full biopsychosocial story, physicians must complement the current physician-centered practices with patient-centered interviewing (1, 2, 11-16). Our aim in this article is to briefly describe what patient-centered interviewing is and why it is important. We then describe how to perform patient-centered interviewing and how to integrate it with presently isolated physician-centered practices

Video-Based Communication Assessment: Development of an Innovative System for Assessing Clinician-Patient Communication

Good clinician-patient communication is essential to provide quality health care and is key to patient-centered care. However, individuals and organizations seeking to improve in this area face significant challenges. A major barrier is the absence of an efficient system for assessing clinicians\u27 communication skills and providing meaningful, individual-level feedback. The purpose of this paper is to describe the design and creation of the Video-Based Communication Assessment (VCA), an innovative, flexible system for assessing and ultimately enhancing clinicians\u27 communication skills. We began by developing the VCA concept. Specifically, we determined that it should be convenient and efficient, accessible via computer, tablet, or smartphone; be case based, using video patient vignettes to which users respond as if speaking to the patient in the vignette; be flexible, allowing content to be tailored to the purpose of the assessment; allow incorporation of the patient\u27s voice by crowdsourcing ratings from analog patients; provide robust feedback including ratings, links to highly rated responses as examples, and learning points; and ultimately, have strong psychometric properties. We collected feedback on the concept and then proceeded to create the system. We identified several important research questions, which will be answered in subsequent studies. The VCA is a flexible, innovative system for assessing clinician-patient communication. It enables efficient sampling of clinicians\u27 communication skills, supports crowdsourced ratings of these spoken samples using analog patients, and offers multifaceted feedback reports

Effectiveness of Manual Therapy, Customised Foot Orthoses and Combined Therapy in the Management of Plantar Fasciitis—A RCT

Background: Plantar fasciitis (PF) is one of the most common causes of plantar heel pain. Objective: To evaluate the effectiveness of three different treatment approaches in the management of PF. Methods: Sixty-three patients (44 female, 19 men; 48.4 ± 9.8 years) were randomly assigned into a manual therapy (MT), customised foot orthosis (FO) and a combined therapy (combined) group. The primary outcomes of pain and function were evaluated using the American Orthopaedic Foot and Ankle Society-Ankle Hindfoot Scale (AOFAS-AHS) and the patient reported outcome measure (PROM) Foot Pain and Function Scale (FPFS). Data were evaluated at baseline (T0) and at follow-up sessions after 1 month, 2 months and 3 months (T1–T3). Results: All three treatments showed statistically significant (p < 0.01) improvements in both scales from T0 to T1. However, the MT group showed greater improvements than both other groups (p < 0.01). Conclusion: Manual therapy, customised foot orthoses and combined treatments of PF all reduced pain and function, with the greatest benefits shown by isolated manual therapy

The Iowa Homemaker vol.25, no.2

Keeping Up With Today, Jeanne O’Connor, page 2 Veishea Blueprints the Future, Charla Muschott, page 3 This is Merrill Palmer, Marjorie Osenbrug, page 4 Home Economists on the Air, Charlene Stettler, page 5 Vicky Faces a Busy Summer, Josephine Ahern, page 6 Alum Directs Army Kitchen in Wales, Lt. Mary E. Scoltock, page 8 Women Devise Costume Jewelry, Madeline Morrison, page 9 Chile Outgrows Food Traditions, Ruth Gaessler, Carlos Krassa, page 10 Summer School or Summer Positions, Victoria McKibben, page 11 What’s New in Home Economics, Doris Adams, page 12 Restaurants Introduce Apprentice Course, Betsy Nichols, page 14 Teach Toymaking, Marjorie Moodie, page 17 Booklet Discusses Teaching Career, Marian Hoppe, page 19 Frances Madigan, ’44, Traveling Journalist, Joan Visser, page 21 Ever Eaten Eggshells?, Lois Gramlich, page 23 Faculty and Students Revise Curriculum, Jeanne O’Connor, page 2

Acute exposure to air pollution particulate matter aggravates experimental myocardial infarction in mice by potentiating cytokine secretion from lung macriphages

Clinical, but not experimental evidence has suggested that air pollution particulate matter (PM) aggravates myocardial infarction (MI). Here, we aimed to describe mechanisms and consequences of PM exposure in an experimental model of MI. C57BL/6J mice were challenged with a PM surrogate (Residual Oil Fly Ash, ROFA) by intranasal installation before MI was induced by permanent ligation of the left anterior descending coronary artery. Histological analysis of the myocardium 7 days after MI demonstrated an increase in infarct area and enhanced inflammatory cell recruitment in ROFA-exposed mice. Mechanistically, ROFA exposure increased levels of the circulating pro-inflammatory cytokines TNF-α, IL-6, and MCP-1, activated myeloid and endothelial cells, and enhanced leukocyte recruitment to the peritoneal cavity and the vascular endothelium. Notably, these effects on endothelial cells and circulating leukocytes could be reversed by neutralizing anti-TNF-α treatment. We identified alveolar macrophages as the primary source of elevated cytokine production after PM exposure. Accordingly, in vivo depletion of alveolar macrophages by intranasal clodronate attenuated inflammation and cell recruitment to infarcted tissue of ROFA-exposed mice. Taken together, our data demonstrate that exposure to environmental PM induces the release of inflammatory cytokines from alveolar macrophages which directly worsens the course of MI in mice. These findings uncover a novel link between air pollution PM exposure and inflammatory pathways, highlighting the importance of environmental factors in cardiovascular disease.Fil: Marchini, Timoteo Oscar. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad Medicina. Instituto de Bioquímica y Medicina Molecular; ArgentinaFil: Wolf, Dennis. University Of Freiburg; AlemaniaFil: Anto Michel, Nathaly. University Of Freiburg; AlemaniaFil: Mauler, Maximilian. University Of Freiburg; AlemaniaFil: Dufner, Bianca. University Of Freiburg; AlemaniaFil: Hoppe, Natalie. University Of Freiburg; AlemaniaFil: Beckert, Jessica. University Of Freiburg; AlemaniaFil: Jäekel, Markus. University Of Freiburg; AlemaniaFil: Magnani, Natalia Daniela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad Medicina. Instituto de Bioquímica y Medicina Molecular; ArgentinaFil: Duerschmied, Daniel. University Of Freiburg; AlemaniaFil: Tasat, Deborah Ruth. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología. Centro de Estudios en Salud y Medio Ambiente; ArgentinaFil: Alvarez, Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad Medicina. Instituto de Bioquímica y Medicina Molecular; ArgentinaFil: Reinöhl, Jochen. University Of Freiburg; AlemaniaFil: von zur Muhlen, Constantin. University Of Freiburg; AlemaniaFil: Idzko, Marco. University Of Freiburg; AlemaniaFil: Bode, Christoph. University Of Freiburg; AlemaniaFil: Hilgendorf, Ingo. University Of Freiburg; AlemaniaFil: Evelson, Pablo Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad Medicina. Instituto de Bioquímica y Medicina Molecular; ArgentinaFil: Zirlik, Andreas. University Of Freiburg; Alemani

Live well, die well – an international cohort study on experiences, concerns and preferences of patients in the last phase of life: the research protocol of the iLIVE study

Introduction Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families. Methods and analysis The iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights. Ethics and dissemination The cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying. Trial registration number NCT04271085

Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

Background International and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda. Methods We did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15–49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population. Findings Between Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positive did not report antiretroviral therapy use, of whom 2652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. 446 transmission networks were reconstructed, including 293 linked pairs with inferred direction of transmission. Adjusting for incomplete sampling, an estimated 5·7% (95% credibility interval 4·4–7·3) of transmissions occurred within lakeside areas, 89·2% (86·0–91·8) within inland areas, 1·3% (0·6–2·6) from lakeside to inland areas, and 3·7% (2·3–5·8) from inland to lakeside areas. Interpretation Cross-community HIV transmissions between Lake Victoria hotspots and surrounding inland populations are infrequent and when they occur, virus more commonly flows into rather than out of hotspots. This result suggests that targeted interventions to these hotspots will not alone control the epidemic in inland populations, where most transmissions occur. Thus, geographical targeting of high prevalence areas might not be effective for broader epidemic control depending on underlying epidemic dynamics. Funding The Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Child Health and Development, the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the World Bank, the Doris Duke Charitable Foundation, the Johns Hopkins University Center for AIDS Research, and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention